Fairview Health Systems Chairman Michael Mooty appearing at U.S Senate hearing on payment collecting practices at Fairview hospitals.

The idea was a basic business proposition.  Get the customer to pay for the services they need before walking out the door.  But in this case the business is a hospital and the customer is sick.

It is under that scenario that Fairview Hospitals in 2010 hired Accretive Health to help it recover more money from patients.  In an era of health care where costs are up and margins are down, the hospital system’s sustainability was increasingly dependent upon securing payment for the care it provided.  The “Revenue Cycle Agreement” between Fairview and Accretive Health ushered in a new culture at Fairview that often times focused on payment before care.

Minnesota Attorney General Lori Swanson

That’s where Attorney General Lori Swanson cried foul.  Her compliance review of Fairview’s contract with Accretive Health released on April 24^th uncovered six volumes of alleged abuses and violations of federal law.  The evidence included internal Accretive Health emails that revealed how the aggressive bill collecting tactics led to some patients leaving the hospital in disgust before seeing a doctor.  In one affidavit, an employee describes how they were forced to obtain payments from patients in the emergency room or they would be fired. (Figure 1)

Figure 1 – Affidavit from MN Attorney General’s compliance review of Fairview hospitals and Accretive Health.

In almost every respect, it is another contemporary case study of an organization losing site of its core values and mission—in this case, the commitment to always put patient care first.

It’s perhaps fair to say that Fairview board chairman Charles Mooty never wanted to become the subject of such a case study.  But Mooty deserves some notice for his handling of the crisis and his attempt to take corrective action.

There are several hard and fast rules to effective strategic crisis management and communications:

1. Cease and desist—stop doing what you’re doing.
2. Apologize to those you’ve wronged—and mean it.
3. Change your tactics.
4. Communicate the change to employees and customers.
5. Establish performance measures for how the change is working.

In a congressional investigative hearing this week, Chairman Mooty followed the script with near precision.  While testifying in a field hearing before U.S. Senator Al Franken, Mooty offered both contrition and a plan for moving forward. Here’s his very strategic response:

1. Cease and desist.

“We’ve stopped collecting past due balances and co-insurance payments in emergency departments, and we’re reviewing emergency department information and workflow processes.”

 “Fairview terminated its work with Medical Financial Solutions, a part of Accretive Health on January 6 of 2012 because of their failure to comply with the Attorney General’s billing and collection agreement.”

 2. Apologize.

“To those patients I offer my personal apology and firm commitment on behalf of the entire Fairview organization to regain your trust.”

3. Change tactics.

“We are reviewing and revising our training tools to ensure each patient interaction reflects Fairview’s core values.” 

 4. Communicate change.

“In addition to our termination of agreements with Accretive Health, we also have initiated better approaches for escalating patient, employee and physician concerns so that they receive prompt attention.”

 This last statement by Mooty perhaps telegraphs what may have been an critically important breakdown within Fairview.  Mooty told the Senate hearing no less than four times that Fairview was going to do a better job of listening to its stakeholders.  Attorney General Swanson’s investigation provided several documents that Fairview doctors and staff had expressed deep concern about the new payment collecting policies instituted by Accretive Health.  Mooty’s testimony strongly signals that those concerns either didn’t get communicated to Fairview leadership, or that leadership simply wasn’t listening.

One of Mooty’s most important changes came during the week before the Senate hearing when he and the board of directors decided not to renew the contract of current Fairview CEO Mark Eustis, the man who hired Accretive Health.  The board named Mooty as interim CEO sending a clear signal that it was breaking with the past.

While Mooty gave no clear indication of how Fairview intends to measure its progress, he clearly used a big stage to send key strategic messages to several key audiences, among them his patients, employees and the public.  But in this case his primary audience is government regulators.  If Mooty can’t convince them that he’s prescribed the right medicine, a more rigorous regimen will be forced from outside rather than inside.

The stakes are high.  So is Fairview’s credibility and trust.

Figure 1 - Pink Slime

Let’s break it down.  In this case, the food additive included in some forms of processed beef came with a descriptive slang name and an iconic image: pink slime. (Figure 1)

In its basic form, pink slime a substance made from the rendered connective tissues and intestines of cows.  Because those tissues are susceptible to e-coli contamination, they are processed with ammonium nitrate to kill the bacteria and act as a preservative.   For years the FDA has approved the additive as a safe filler for meat products.  But when an image and video of the substance appeared in the news reports in early March about its presence in school lunch hamburgers, pink slime became a household word as fast as parents could hit the “send” button on their computers.   As a Google Trends analysis shows, pink slime went viral in a matter of 24-hours and has not let up since. (Figure 2)

Figure 2 - Google Trends

Three key factors are involved here.  First, the image itself of the pink slime became what social psychologist Jaap Van Genneken would call a strong replicator.  In other words, it’s an iconic image that developed and sealed an emotion in the minds of the viewer.  In this case, the image leads to the very human response of questioning what this substance is doing in our food—especially our children’s food at school.

Second, the image sealed itself in the minds of an important audience.   That audience is mainly women, in particular, the mothers of school children.

Third, these women not only saw the image of the pink slime included in stories in various news media, they spread the story to their friends and peer groups in social media.  My own audience research among social media users indicates that women are heavily invested in, and are heavy users of social channels.   They not only use social media as a way of discovering news from their friends, but to share news and issues that are important to them.   When this story broke, the image, the issue, and the salience to their children and families created its own perfect recipe for a modern-day social issue contagion. (Figure 3)

Figure 3 - Contagion Model

The result has been a sudden abandonment of meat products containing the so-called pink slime.  Several major grocery store chains have now said they have stopped ordering beef products containing the additive.   One of them is Twin Cities based SuperValue which owns and operates Cub Food stores throughout the Midwest.   Here’s its statement:

“We’ve heard concerns from many of our shoppers about the inclusion of finely textured beef in some of the ground beef products available at our stores. Effective today, we have made the decision to no longer purchase fresh ground beef products that contain finely textured beef.”  -SuperValue

            The power of the contagion lies in the statement’s first sentence.   Consumers spoke up.  SuperValue listened.  It’s a 21^st century lesson in the speed of which issues closely tied to strong memes can spread, and the power of key audiences armed with a “send” button.

               Susan G. Komen somehow hung itself.  Somewhere, someone inside the organization cut the rope just in time.   But, it’s gasping for air.

                The tragedy in its decision to cut off funds to Planned Parenthood not only damaged the image of an exceptionally worthy organization and powerful super brand, it potentially threatened the lives of the some of very women it has promised to serve.  The question is, how did this happen? 

                The legal and moral arguments over the Komen’s initial decision to pull its grants from Planned Parenthood have been well documented.  Komen was getting increasing pressure from the right to life movement to no longer fund breast cancer screenings at an organization that also provides abortions.  How Komen responded to the pressure will be analyzed in case studies that compare it against such classic PR disasters as New Coke, and more the more recent debacles of ACRON, Go Daddy, and SOPA .   Each has its unique set of circumstances, yet each has its similarities.   They all lost track of their audience, their value proposition, and their soul.   But what compounded Komen’s disaster was the speed and means by which its stakeholders struck back.  Social media channels provided the platform and the echo chamber for the outrage to spread like a contagion.

                The outrage begins with what a significant number of Komen’s loyalists and evangelists viewed as a violation of trust.  Komen’s core mission is saving the lives of women.  It’s website boldly states, “Susan G. Komen for the Cure is fighting every minute of every day to finish what we started and achieve our vision of a world without breast cancer.”  It’s not just a credo, it’s a commandment. 

                Komen’s founder and CEO, Nancy Brinker proclaims, “We’re proud of the fact that we don’t simply dump funds and run.  We create activists—one person, one community, one state, one nation at a time—to try and solve the number one health concern of women.”

                But Komen’s announcement that it would suspend eligibility for further grants to Planned Parenthood for breast cancer examinations seemingly violated its core proposition and values.    Brinker attempted to argue in a YouTube video that the decision was not politically motivated.  But in a world where perception is reality, no one bought it.   Tragically, Komen, never saw it coming.

                From a pure communications analysis, Komen’s actions were incongruent with both with its mission and its constituents.  What it failed to take into account is that Planned Parenthood is also a regarded women’s health organization with considerable overlap among Komen’s own activists and volunteers.  I’ve created a simple heuristic model that shows the positive and negative congruencies between Komen, Planned Parenthood and women.  (Figure 1)

Figure 1 - Komen's Communications Incongruency Model

             Planned Parenthood has a loyal constituency of its own.  Among its supporters is New York Mayor Michael Bloomberg.  When Bloomberg took to Twitter and announced a $250,000 donation to Planned Parenthood, it leveraged more money and buzz. (Figure 2)

Figure 2 - New York Mayor Michael Bloomberg's Tweet

                What Bloomberg effectively achieved was a new congruency.  (Figure 3)  Women and donors who support both Planned Parenthood and Komen didn’t take to the streets, they followed Bloomberg and took to their smart phones and computers.  

Figure 3 - Mayor Bloomberg's Communcation Congruency Model

             The outrage in social media channels such as Facebook and Twitter spread faster than the opening steps of a Komen 3-Day event.   A little more than 24-hours after Brinker took to Youtube defending Komen’s actions, the organization issued an abrupt apology and restored funding to Planned Parenthood.  The carefully crafted message reads as follows:  “We want to apologize for recent decisions that cast doubt upon our commitment to our mission of saving women’s lives.”   In other words, they rediscovered their soul and their credo.

                 Which brings us back to Komen’s initial decision.  How would the course of events been different had the executive leadership made its decision based upon the organization’s core values and mission?  These are the same questions Komens  PR agency, Ogilvy, will have to ask as well.  In the coming days Ogilvy will have to craft a set of strategic messages to satisfy not just Komen’s supporters of Planned Parenthood, but those supporters who strongly oppose that fact that Planned Parenthood also provides abortion counseling.  The tragedy is that unless Ogilvy is working pro-bono, Komen will spend a huge sum of money on damage control that otherwise would have gone to breast cancer research.

                Komen will likely recover and catch its breath.  But it’s near death experience is a valuable lesson for organizations to constantly pay attention to their core values.  If not, in this new world order of social democracy, their followers will hold them accountable.

            The slick color direct mailer went out to 10,000 customers with a nice $5 coupon.  The mailer trumpets a newly remodeled Applebee’s in Maple Grove, MN.  Any marketing executive would tell you it’s a great and efficient “activation” driver to bring lapsed users into the restaurant.  Tragically, the headline on the back of the mailer launches another driver: Buzz.  And this buzz is not good.

            Here’s the headline:  “REDISCOVER YOUR WHITE MAPLE GROVE APPLEBEE’S!”

Applebee's Mailer

            It speaks for itself.  Applebee’s did not.

            Several irritated viewers contacted us about the mailer wondering how could the neighborhood restaurant be so insensitive?  It turns out it was a printing
mistake.   Similar mailers were created earlier in the year for the reopening of the Applebee’s in White Bear Lake, MN.  Applebee’s believes the printer didn’t quite
interchange all of the words.

            When Fox 9 contacted the corporate spokeswoman, there was no apology and little explanation.  My colleague Erik Runge, a good and seasoned reporter, was stunned.  He inquired about getting an interview from someone at Applebee’s explaining the error and was denied.  He then asked about getting a written statement and again—denied.

            There are some basic rules about crisis management.  One of them is get ahead of the discussion.  But the most important rule is to become a part of the discussion.  Applebee’s corporate silence is equivalent to sticking its head in the sand.   By not becoming a part of the narrative, they let everyone else—including their customers and the media—create the narrative for them.  Once that happens, they have lost control of their brand.

             Those of us who are Applebee’s customers know it as a good neighborhood restaurant chain with great service.  The tragedy is it’s painfully obvious that the spokeswoman in the corporate office is not committed to the brand or its soul.

            She needs to be force-fed some PR soul food.  And then she needs to be fired.